Information
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Document No.
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Lockout/Tagout Periodic Inspection
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Manufactured Packaging Products
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Conducted on
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Prepared by Cristina Cook
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Co-workers Present
Pre-certification Prepared by trainer/supervisor
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Co-worker has been trained in MPP LOTO procedures for assigned task
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Co-worker can identify all stored & kinetic energy sources of equipment<br>
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Co-worker has been issued locks, keys, hasp, and tags as needed and appropriate.
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All locks are unaltered and uniform with plant standards; clearly identify ownership
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Observed Employee
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Supervisor/Trainer
Lockout/Tagout Process
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Step 1- Identify energy sources
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Step 2- Notify others (affected Co-workers and other personnel in area)
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Step 3- Shut down the equipment using normal stopping procedures for the equipment<br>
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Step 4- isolate the equipment from the energy source
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Step 5- Lock out the equipment by affixing locks to each energy sources controlling device
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Step 6- Release stored energy (electrical, mechanical, hydraulic pneumatic, chemical, thermal, etc)
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Step 7- Ensure area is clear of all personnel and verify isolation<br>
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Step 8- Perform servicing
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Step. 9- Release the equipment from lockout/tagout
Verification
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Co-worker was able to conduct Lockout/Tagout process correctly and all steps were conducted sequentially
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Co-worker demonstrates ability and knowledge to properly conduct lockout/tagout when necessary
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Co-worker understands that he/she will be subject to periodic audits as deemed necessary by management<br>
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Co-worker understands that violation of lockout/tagout policy can and will result in disciplinary action, up to and including termination
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Auditor Signature
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Supervisor Signature
